Measles and Rubella Global Update SAGE 19 October 2017

Transcription

1 Measles and Rubella Global Update SAGE 19 October 2017 Alya Dabbagh WHO HQ, IVB/EPI

2 Global update Overview Regional progress and challenges M&RI Midterm Review updates Economics of measles and rubella elimination Conclusions Proposed recommendations 2

3 Measles and Rubella Targets Global: World Health Assembly, 2010 By 2015: MCV1 coverage 90% national and 80% in every district Measles reported incidence <5 cases/million Measles mortality reduction of 95% vs Regional elimination (GVAP, 2012): By 2015: Elimination of measles in 4 WHO Regions Elimination of rubella in 2 WHO Regions By 2020: Elimination of measles & rubella in 5 WHO Regions 3

4 Global Update

5 Milestone #1: 90% MCV1 Vaccination Coverage in Every Country 123 (63%) countries have >90% coverage with 1 st dose of MCV 44 (23%) with MCV1 coverage 90% national and 80% in every district 0 1,050 2,100 4,200 Kilometers Source: WHO/UNICEF coverage estimates 2016 revision, July Map production: Immunization Vaccines and Biologicals (IVB), World Health Organization. 194 WHO Member States. Date of slide: 19 July 2017 <50% (7 countries or 4%) 50-79% (32 countries or 16%) 80-89% (32 countries or 16%) 90-94% (43 countries or 22%) >=95% (80 countries or 41%) Not available Not applicable The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved Immunization coverage with 1 st dose of measles containing vaccines in infants,

6 Measles global annual reported cases and MCV1 and MCV2* coverage, Date of chart: 02 August 2017 number of cases 5,000,000 4,500,000 4,000,000 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000, , % 64% 132, immunization coverage (%) Number of cases MCV1 coverage MCV2 coverage Source: WHO/IVB database, WHO Member States. Data as of 19 July 2017 *MCV2 estimates is only available from 2000 when global data collection started, however some countries have introduced the vaccine earlier. 6

7 Increasing Measles Second Dose Countries using Measles Second Dose vaccine to date;; and planned introductions in 2017 Introduced to date (165 countries or 85.1%) Planned introductions in 2017 (7 countries or 3.6%) Not Available, Not Introduced/No Plans (22 countries or 11.3%) Not applicable % Countries Introduced 51% 85% more countries Data source: WHO/IVB Database, as of 09 August 2017 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization 7 The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved.

8 Milestone #2 Measles Incidence <5 cases/million Number of reported cases /m Measles reported incidence down by 87% 19 per million, /m WPR SEAR EUR EMR AMR AFR

9 Milestone #2: Measles Incidence <5 cases/million 2010: 60% countries <5 cases/million 2016: 69% of countries <5 cases/million Based on CB data received and covering the period between and Incidence: Number of cases / population* x 1000,000 - * World population prospects, 2017 revision - 9

10 Global Milestone #3 95% Reduction in Measles Deaths Estimated number of deaths Measles deaths down by 79% ( ) Estimated deaths by Region, 2015 (Total 134,180) AFR AMR EMR EUR SEAR WPR Year 20.3 million deaths prevented since 2000 by measles vaccination 10

11 Countries with Rubella vaccine in the national immunization programme; and planned introductions in % Countries Introduced 82% 60 more countries % Introduced to date* (159 countries or 82%) Planned introductions in 2017 (5 countries or 2.6%) Not Available, Not Introduced/No Plans (30 countries or 15.5%) Not applicable Data source: WHO/IVB Database, as of 09 August 2017 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved. * Includes partial introduction 11

12 2016 Global RCV Coverage 47% Rubella containing vaccine 1 st Dose (RCV1) coverage* by WHO region, RCV1 coverage (%) Global AFR AMR EMR EUR SEAR WPR Source: WHO/UNICEF coverage estimates 2016 revision, July *coverage estimates for the 1rst dose of rubella Immunization Vaccines and Biologicals (IVB), World Health containing vaccine are based on WHO and UNICEF Organization. estimates of coverage of measles containing WHO Member States. Date of slide: 15 July vaccine.

13 Surveillance sensitivity reporting rate of measles and rubella (12 months, discarded cases* per 100,000 population) Rate >= 2 (61 countries or 31%) 1 < Rate < 2 (26 countries or 13%) Rate <= 1 (56 countries or 29%) Insufficient Data (51 countries or 26%) Not Available Based on data received and covering the period between and Target: >= 2 discarded cases* / 100,000 population** - * Suspected cases investigated and discarded as non-measles non-rubella using laboratory testing and/or epidemiological linkage to another etiology ** World population prospects, 2015 revision Data source: IVB Database - Map production: IVB/EPI World Health Organization, WHO, All rights reserved Disclaimer: The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. 13

14 Regional Update

15 Measles and Rubella Eliminated in the Americas Announcement of measles elimination in the Americas, 27 September

16 Key Regional Achievements One Region achieved and sustained measles & rubella elimination (AMR). 12 AFR countries near elimination* and an additional 14 on track for the 2020 goal. High level of control achieved in 7 EMR countries, of which, Bahrain, Oman and Palestine are ready to verify elimination. High coverage with 2 doses of MCVs (AMR/EUR/WPR). Three regions with all countries having introduced RCV (AMR/EUR/WPR). India and Indonesia introducing rubella vaccine in (>470 million targeted through SIAs). In 2016, reported measles cases at all- time low in AMR/AFR/EMR/EUR. RVC esteblished and functioning in 4/6 Regions. With three regions verifying rubella elimination (AMR/EUR/WPR). *Algeria, Burkina, Cape Verde, Rwanda, Eritrea, Gambia, Ghana, Mauritius, Senegal, Seychelles, Sao Tome, Zimbabwe 16

17 Scorecard on Verification of Elimination, Oct WHO Region (no. countries) Americas (n=35) Europe (n=53) Western Pacific (n=27) Regional Verification Commissions Established Yes Yes Yes Elimination Achieved No. of countries Measles: 35 Rubella: 35 Measles: 33 Rubella: 33 Measles: 6 Rubella: 2 % of countries Eastern Mediterranean (21) In process % 100% 62% 62% 22% 7% South-East Asia (n=11) Yes Measles: 2 18% Africa (n=47) In process - - TOTAL 17 Measles: 76 (39%) Rubella: 70 (36%) EUR: 7 (13%) additional countries interrupted measles transmission for >12 m but <36 m. 4 (7.5%) additional countries interrupted rubella transmission for >12 m but <36 m.

18 Key Regional Challenges (1) Gaps in population immunity due to: o Weak and fragile health systems in many countries (AFR/EMR) o Civil unrest, famine, active conflict (EMR) o Vaccine hesitancy (EUR) o Declining maternal antibody levels Susceptibles distributed across increasingly wide age groups, making eventual elimination more expensive & more technically difficult (EUR/WPR). Outbreaks affecting adolescent and adults, migrants, religious groups (EUR/WPR) Infants <1 year old affected by measles (EUR/WPR). 18

19 Key Regional Challenges (2) Maintaining elimination in the face of ongoing importations (PAHO/EUR ) No target for rubella /CRS elimination (AFR/EMR/SEAR) No target date for rubella elimination (WPR) Low commitment to elimination in some member states Inadequate resources to fully implement recommended strategies: o Inadequate resources for wide age- range campaigns to address population immunity gaps o Steadily declining resources through M&R Initiative o Lack of resources for surveillance (AFR/EMR/SEAR) o Polio transition (AFR/EMR/SEAR) 19

20 Challenge: Polio Transition 16 countries with largest polio assets RISKS: Polio virus transmission if re- introduced Resurgence of measles and rubella 88% of estimated measles deaths occur in these countries Most of the world s rubella and CRS cases (100,000) Polio field staff spend nearly 1/3 of their time working on RI & MR. Critical for SIA quality and surveillance Estimated $77 million (70%) of annual needs for VPD/MR surveillance are coming from polio $$ Over 2500 polio- funded staff are supporting VPD/MR surveillance 20

21 Midterm Review of the Global Measles and Rubella Strategic Plan W. A. Orenstein, MD SAGE Geneva, 19 October 2016

22 Progress with MTR Recommendations Increase emphasis on surveillance o Global guidance updated Urgent need to strengthen the collection and use of surveillance data o At risk Strengthening of RI systems is critical to achieving regional elimination goals. Need to move from SIAs to primary reliance on ongoing routine services o On going (tools developed) Develop a standardized method to categorize countries based on their level of disease control. o Completed 22

23 Strengthening of RI Systems RI is critical for achieving the elimination goals: > 95% coverage with 2 doses of MCV is needed Central theme for M&R Initiative Strategic Plan ( ) and ongoing activities 2/3 of measles cases averted through RI (J. Inf Dis. 204, 2011) Studies demonstrate that properly planned SIAs can strengthening RI (E.g.,): Improve micro- planning, training and supervision of HCW Improvement of CC, waste management system & injection- safety standards strengthened AEFI surveillance MCV2 in the 2YL offers an ideal opportunity by: fixing an immunization/health check contact during 2YL (e.g. growth monitoring, booster doses, Vit A) catch- up vaccination for all missed vaccines Measles vaccination school entry checks can improve coverage of other VPDs. Measles Outbreaks as an indicators of weak RI: Measles is highly infectious and seeks out susceptibles; disease is highly visible, Outbreaks identifies gaps in RI programs and population groups missed by RI. 23

24 Country Categorization in relationship to Elimination Objectives: To standardize the country categorization used globally To document the progress toward elimination Country Eliminated and Verified Eliminated/ Interrupted but not Verified Re- established Post- Verification Endemic 24

25 Economics of MR vaccination High return on investment for measles vaccination in low- and middle- income countries 1 $58 return on $1 invested Current level of control costs $98 billion annually 2 : Programme ($2 billion) Treatment ($8 billion) Cost of lost productivity ($88 billion) Published studies show high cost- effectiveness Measles and rubella are eradicable with potential for cost- savings 3 Earlier estimate of cost of measles eradication of $8-14 billion 4 Results from eradication investment case expected by end Ozawa S et al., Health Affairs 2016; 35(2): Thompson KM, Odahowski CL, Risk Analysis, 2016; 36(7): , Aug 6, 2015, doi: /risa WHO. Weekly Epidemiological Record,No 6, 12 February 2016, 91, Bishai et al., J Vaccines Vaccin 2012, S:

26 Summary Substantial progress in measles control since 2000 Elimination of measles and rubella in the Americas Good recent progress in all regions 2015 global and 3 regional targets were not met Midterm review providing a road map RI strengthening is critical and a central theme It is urgent that polio assets are assured to sustain the measles, rubella & other immunization functions that are currently supported through PEI funds. 26

27 Proposed SAGE WG Recommendations The four proposed country categories are appropriate and provide a standardized approach to country categorization. RVCs are encouraged to use the proposed categories. In order to make further gains in reducing the global burdens of measles and rubella, it is urgent that measles and rubella elimination receive a high priority for transition of PEI resources. 27

28 Thank you! Thanks to: MR SAGE WG members Katrina Kretsinger Laure Dumolard Minal Patel Thomas Cherian